May is Maternal Mental Health Awareness Month (MMHA) and the perfect time to focus on the importance of mental health during the perinatal period, the time frame of pregnancy (prenatal), and through the first year after giving birth (postpartum). In line with MMHA month, we are diving into the definition and types of perinatal mood and anxiety disorders (PMADs), the signs and symptoms, as well as the risk factors and resources.
“In many countries, as many as 1 in 5 new mothers experience some type of perinatal mood and anxiety disorder (PMD). These illnesses frequently go unnoticed and untreated, often with tragic and long-term consequences to mothers, children, and fathers alike.” - Awareness Days
The information below focuses on recognizing symptoms of a PMADs, and how different they are from the “baby blues/postpartum blues”. Note, this information is not a substitute for personal medical advice, diagnosis or treatment. If you have any questions or concerns about your health, or that of a loved one, please consult your healthcare professional for immediate screening and care.
Baby Blues
Most birthing people experience baby blues after giving birth (approximately 60-80% of women will experience this). Baby blues tend to begin after about 2 days postpartum, peak at 3-5 days after delivery, and last up to 2 to 3 weeks. Baby blues can present themselves differently in people. A few common occurrences include:
Decreased concentration, difficulty thinking clearly, or feeling out of touch
Appetite changes
Trouble sleeping / falling asleep
Feeling very tired
Mood swings
Anxiety
Irritability - feeling easily annoyed/angry and not knowing why
Feeling overwhelmed
Crying often, and for no apparent reasons
Not feeling like yourself
Baby blues can occur for a variety of reasons including, sudden hormone fluctuation, acute sleep deprivation, change in routine, stress, excitement, and uncertainty. They usually go away on their own. Time, patience, sleep, and the positive support of family and friends help in lifting the symptoms.
Although the initial baby blues are common, if you find your symptoms and negative feelings worsening or lingering for more than a few weeks, and continuing to interfere with everyday living, you may be experiencing perinatal mood and anxiety disorder (PMADs). Please know that you do NOT need to meet all of the symptoms below to be experiencing a PMAD. Every person is different with how it presents.
Types of PMADs
Perinatal depression
Perinatal anxiety disorder
Perinatal obsessive-compulsive disorder (POCD)
Perinatal post traumatic stress disorder (PPTSD)
Postpartum psychosis
Perinatal Depression
Between 10% to 20% of birthing people experience perinatal or postpartum depression, perhaps even more given that the diagnosis goes highly unreported. Below are some of the more commonly experienced indicators:
Overwhelmed, “feel like I can’t cope”
Difficulty bonding with the new baby
Inability to take care of one self or one’s family
Withdrawing from family and friends
Diminished ability to think clearly, concentrate or make decisions
Low mood, sadness, tearfulness and/or severe mood swings
Feelings of hopelessness, worthlessness, shame, guilt or inadequacy
Appetite and/or sleep disturbances
Reduced interest and pleasure in activities you used to enjoy
Irritability
Possible thoughts of harming oneself or the baby
Perinatal Anxiety Disorder
During pregnancy, and postpartum, most people feel physically and emotionally overwhelmed. New parents may feel like there’s a thousand things to worry about. It can cause a person great distress, and have an impact on their daily life. The prevalence for prenatal anxiety is about 15%, and about 8 to 20% postpartum. Symptoms include:
Excessive anxiety and worry (often about one’s health or baby’s health)
Feeling like something bad is going to happen
Difficulty controlling one’s worry (ruminating, persistent thoughts)
Agitation, irritability
Restlessness, inability to sit still, feeling on edge
Feeling of fear or uneasiness
Easily fatigued, sleep disturbance (difficulty falling/staying asleep)
Physical symptoms like muscle tension, palpitations, racing heartbeat, shortness of breath, headaches, nausea
Perinatal Obsessive-Compulsive Disorder (POCD)
Some experience OCD in the perinatal period, without ever having any previous diagnosis of an anxiety disorder. The prevalence is about 3-5%, with postpartum individuals being 1.5 to 2 times more likely to have OCD, compared to the general population. Around 65% of birthing people with postpartum OCD also have an underlying mood disorder, such as depression. The symptoms of OCD are:
Obsessive, intrusive, repetitive, unwanted, and upsetting thoughts or mental images that cause anxiety/distress (often related to the baby)
Compulsive behaviours that are performed in response to the thoughts, and aimed at preventing, or reducing the anxiety/distress (e.g. cleaning constantly, reordering things, or checking things many times).
A sense of horror, and disgust about the thoughts/mental images
“What if” thinking
Fear of being left alone with the baby
Hypervigilance, heightened alertness and preoccupation with protecting the baby
It’s important to know that a parent with OCD understands the strange nature of their thoughts, and is frightened by them. They are unlikely to act on these intrusions, as they often take steps to avoid triggers and protect the baby. Unfortunately, many women feel tremendous guilt and shame for having these thoughts and feelings, which prevent them from reaching out for support. People need to remember that thoughts do not equal action, and that they are not alone. Help is available.
Perinatal Post Traumatic Stress Disorder (PPTSD)
The prevalence of PPTSD is about 9%. It’s often unrecognized, poorly characterized and undertreated. PPTSD arises after a real, or perceived traumatic or frightening event. Potentially traumatic perinatal events include:
Emergency/unplanned c-section
The use of forceps or vacuum extraction
Severe pre-eclampsia
Postpartum hemorrhage
Long labor process
Fetal anomalies diagnosis during pregnancy
Feeling of powerlessness
Poor communication and/or lack of support and reassurance during the delivery.
This leads to specific negative symptoms and consequences such as:
Difficulty sleeping
Poor parent-infant bonding
Nightmares about labor and delivery
Avoidance of stimuli (thoughts, feelings, people, places, and details) associated with the event associated with the event.
Anxiety and panic attacks
Flashbacks, re-experiencing of the traumatic event
Avoidance of postpartum care, and/or future pregnancies
Sexual dysfunction
Increased arousal (irritability, difficulty sleeping, hyper-vigilance, startle response)
Postpartum Psychosis
Fortunately, only a very small number of women (about 1 in 1000) suffer from this severe form of mood disorder. The onset of postpartum psychosis is usually within the first two weeks after birth, and requires immediate diagnosis and treatment. Symptoms tend to be extreme, and may include the following:
Poor concentration, and disorientation
Extreme confusion, disorganized thoughts, jumping rapidly between ideas and thoughts.
Agitation, hyperactivity
Rapid, and exaggerated mood changes
Inability to sleep (even when exhausted), or excessive energy and not needing to sleep
Distrusting other people
This kind of psychosis can also cause a person to have obsessive thoughts about herself, or her baby and bring on hallucinations. Risks to the birthing person or the baby are also possible, which is why it's so important to seek treatment right away.
Causes and Additional Risk Factors
There is no one reason PMADs occur. However, some people may be more susceptible to experiencing PMADs if they have experienced any of the following risk factors.
Family or personal history of previous PMADs, depression, anxiety, OCD, eating disorder, etc.
Social factors, such as isolation, lack of support from a partner, family or friends, recent loss, or financial stressors
Hormonal fluctuations
Abrupt discontinuation of breastfeeding
Sleep deprivation and stress
A difficult birth (can include a long, hard labor, emergency C-section, a baby in the NICU)
Issues related to breastfeeding (pain, engorgement)
Outside pressure or a type A personality, as it may cause women to worry excessively or bend to societal expectations to be the “perfect parent”
Prior trauma, such as sexual assault, a grave accident, great fear of childbirth or having had fertility treatments
Getting Help for a PMAD
If you are experiencing a PMAD, know that you are not alone. There are countless helpful resources and support groups to guide you through these difficult times. If you are struggling with mental health in the perinatal period, the most important thing you can do for yourself, your loved ones, and your child, is speak up. Asking for help is not a sign of weakness or a critique on your ability to be a ‘good parent’, it’s a sign of strength and self awareness.
Additional Resources & Services
Postpartum Support International is a wonderful resource hub filled with information, online support groups, numbers to call and text, and access to local resources to help a person, and families dealing with postpartum.
Here is a great resource centre filled with stories from women & parents who have experienced postpartum anxiety & depression.
The 4th Trimester Project is filled with helpful information for new parents, and prioritizes the idea of building your village & community. Read through blogs, health concerns, and hear from women in similar situations building a supportive community.
Wishing you well on this journey!
Kindly,
Val